The knee joint is susceptible to three forms of arthritis.
The most common type of knee arthritis is Osteoarthritis (OA), which is a degenerative disease that progresses slowly as the cartilage of the joint wears away. Middle-aged and elderly individuals are most vulnerable to OA.
Rheumatoid arthritis (RA) can occur at any age and usually impacts both knees simultaneously. RA is inflammatory and destroys the cartilage of the knee.
When the knee is injured, post-traumatic arthritis may develop in a form similar to OA. Post-traumatic arthritis can occur at any time following knee injury and often occurs following fractures, minisci tears, and ligament injuries.
A healthy knee
An osteoarthritic knee
The pain associated with arthritis can develop suddenly or gradually, though gradual development is more common. The swelling that occurs with arthritis can cause stiffness and reduce mobility of the knee.
Several factors tend to increase the pain associated with arthritis including time of day (pain is usually worse in the morning), inactivity, extreme bending (such as that which occurs with kneeling or climbing stairs), and changes in weather. The pain is often also associated with a sense of weakness which can lead to knee buckling.
When your orthopedic physician examines your knee for arthritis, he or she will focus on the level of swelling and pain as well as your knee’s range of motion and the nature of your walk.
If your physician believes you may have arthritis, you may undergo an x-ray. The observation of loss of joint space around the knee is an indicator of arthritis.
A healthy knee
An osteoarthritic knee
There are a plethora of potential treatments for OA of the knee, which provides an opportunity for customizing treatment to the individual. Each patient, together with a physician, should discuss strategies for treating OA.
The goals of treatment are pain reduction and maintaining or increasing range of motion and function. Depending on the relative importance of each of these goals, patients may choose different treatments.
Nonsurgical treatments are generally employed early in the development of arthritis. These treatments may include heat or ice application, water exercises, or bandages. They may also involve the following:
Lifestyle modifications aim to reduce stress on the knee, which exacerbates arthritis and its symptoms. Some strategies include weight loss, modifying exercise regimes to protect knees. Because many people with OA are overweight, it is not recommended that these patients cease exercising all together. Instead, walking regularly can be an effective option for these patients.
Specific exercises can be employed to maximize flexibility around the knee and increase range of motion. Strengthening the muscles around the knee can be beneficial for knee support, and physical therapy can help reduce pain and improve function. The specific exercises each patient engages in can be determined by the patient and physician depending on the needs and desires of the patient.
Supportive devices that help take pressure off the knee can offer relief with OA. Such devices include canes, energy-absorbing shoes, shoe inserts, braces, and knee sleeves. Braces can be particularly helpful when stability is required. Support braces support the whole knee, whereas unloader braces help shift load away from the parts of the knee that are swollen or painful.
Knee arthritis can be treated with a variety of drugs. Your physician can help you find the right drug for you. All drugs can have adverse side effects, and we are also prone to build a tolerance to drugs, which reduces their effectiveness. Drugs, including over-the-counter drugs, also have the potential to interact with other drugs. You should therefore always discuss details of your medication with a physician before changing your treatment regimen. Some drug options are:
Common Medications: Anti-inflammatory drugs like aspirin or ibuprofen can reduce joint swelling. Mild pain relievers like Tylenol can also help with swelling. Such treatments are usually the initial mode of treatment in knee OA.
Glucosamine and Chondroitin Sulfate
These oral supplements may relieve pain associated with OA. Becasue these molecules are naturally found in joint cartilage, supplements can help restore normal cartilage structure and function. The positive effects associated with these drugs can take a few months, so these options cannot be relied on for immediate relief. You can find supplements that are over-the-counter. Side effects to be aware of are headaches, nausea, vomiting, and reactions of the skin.
Corticosteroids can be injected into the joint when pain and swelling are moderate to severe. These drugs are strong anti-inflammatory agents and can be very useful in improving the mechanics of the joint.
These hormones, produced by the adrenal glands, provide pain relief in addition to reducing inflammation. However, pain relief is only short-term, so multiple injections are required for this treatment. A downside to this treatment is that swelling can actually be worse immediately after the injection, and there is potential for long-term damage to the joint as well as infection.
Viscosupplementation with Hyaluronic Acid
Hyaluronic acid can be injected into the knee joint in a relatively new procedure called viscosupplementation. Synovial fluid surrounds the knee, to provide a lubricant to improve the ability of bones to move smoothly around each other. Hyaluronic acid is normally found in that fluid, but people with OA have low hyaluronic acid levels in their synovial fluid. This treatment can thus help compensate for the loss of this protective agent.
If knee arthritis does not respond to nonsurgical treatments, knee surgery is an alternative option. Surgical options include the following:
Surgeons can see inside the knee joint using arthroscopic surgery and can then remove debris and torn cartilage. This strategy is most useful when OA is mild.
If the knee joint cartilage is severely damaged, a total or partial arthroplasty may be needed. This procedure replaces the cartilage with metal and plastic.